Etiology and incidence of maxillofacial skeletal injuries at tertiary care hospital, Larkana, Pakistan.
The objective of this study was to determine the causes incidence and distribution of maxillofacial injuries. This was a descriptive study performed at the tertiary care hospital of Larkana (Accident and Emergency Department of Chandka Medical College Hospital and Outpatient's Department of Bibi Aseefa Dental College Hospital Larkana) from 1st February 2011 to 30th August 2013.
Two hundred and eighty eight patients of maxillofacial injuries were included in this study patients less than 11 years of age suffering from neurological disorders and patients with isolated cases of dental and nasal injuries or only with facial lacerations were excluded. Information and data were collected from history clinical examination and surgical preoperative records of each patient.
Results showed that the most common etiology was road traffic accident (170) 59% interpersonal violence (31) 10.76% gunshot injuries (28) 9.7% falls (19) 6.5% and others (40) 13.88%. The mandi- ble was the most frequent bone fractured which accounted for (148) 50.38% followed by zygomatic complex (52) 18% and (24) 8.3% maxillary bone. Fracture in combination form involved (64) 22%.
It was concluded that road traffic accident was the most common etiological factor of maxillofa- cial skeletal trauma while second most common cause was the interpersonal violence. Mandible was the most commonly fractured bone.
Key Words: Maxillofacial skeletal trauma fracture road traffic accident.
Injuries to the maxillofacial region present one of the most challenging problems for health care profes- sionals worldwide. Particular interest was developed by the high incidence and diversity of facial fractures.
Fractures of the maxillofacial skeleton are invariably associated with substantial morbidity disfigurement functional deficit and high cost for treatment.2 The causes differ among developing countries from those in developed countries. In published studies from Nigeria3
Libya4 Europe5 and United States6 indicate that road traffic accidents was the main cause of maxillofacial injuries. Current studies show that interpersonal vio- lence is leading source of facial fractures in developed countries where as road traffic accident remains major etiology in underdeveloped countries.7
status social education and behaviour various cultural thoughts differences in sects and religions industri- alization transportation lack of driving skills alcohol consumption and legislation all may contribute in establishing the prevalence of the various causes.
According to anatomical site of distribution man- dible and zygomatic complex fractures are the most prevalent sites and their occurrence varies with the mechanism of injury and demographic factors.4
The coordinated and sequential collection of data concerning chronological and demographic patterns of maxillofacial injuries may help health care providers to make a record of facial trauma. Ultimately an un- derstanding of the cause severity and chronological distribution of maxillofacial trauma permit clinical and research priorities to be established for effective treatment and prevention of these injuries.5
First time this type of study was carried out at peripheral areas of Sindh to highlight the main issues regarding causes type and pattern of maxillofacial skeletal injuries in relation to age and gender.
The main aim of this study was to trace the full profile of maxillofacial trauma victims seen at emer- gency or outpatient's department for understanding the causes incidence and temporal distribution of max- illofacial trauma which may help to establish clinical priorities for the effective treatment and prevention of these injuries.
Two hundred and eighty-eight patients with maxil- lofacial skeletal injuries were seen in the tertiary care hospital of Larkana (Accident and Emergency Department of Chandka Medical College Hospital and Outpatient's Department of Bibi Aseefa Dental College Hospital Larkana) from 1st February 2011 to 30th August
2013. Patients who sustained maxillofacial skeletal injuries were included where as patients less than 11 years of age neurological disorders and patients with isolated cases of dental and nasal injuries or only with facial lacerations were excluded. Information and data were collected from clinical examination and surgical preoperative records of each patient.
The obtained data included:
- Patient's demographic details including age gender and race
- Etiology with respect to age group
- Fracture site with respect to age group
SPSS version 16.0 was used to analyze the collected data.
Two hundred eighty-eight patients with maxillo- facial skeletal injuries formed the study group. Male were dominant with 81% (n-233) while 19% (n-55) were females Fig 1. Most effects patients were in sec- ond to third decades. Road traffic accidents were the most common cause (n-170) 59%. Furthermore motor cyclists and walkers were the top victims. Interper- sonal violence (n-31) 10.76% was on second followed by gunshot injuries (n-28) 9.7% falls (n-19) 6.5% and others (n-40) 13.88% as mentioned in Table 1. Mandible was involved in 50.38% cases followed by zygomatic complex (n- 52) 18% and (n-24) 8.3% maxillary bone. Fracture in combination form involved (n- 64) 22% Table
2. Patients with significant proportion had fractures in combination form.
TABLE 1: ETIOLOGY OF MAXILLOFACIAL SKELETAL INJURIES
S. Etiology###No. of###Per-
1.###Road traffic accidents###(n-170)###59%
TABLE 2: DISTRIBUTION ON THE BASIS OF BONE INVOLVED (n=288)
S. Bone involved###No. of###Per-
2.###Zygomatic bone###(n= 52)###18%
Maxillofacial trauma is usually caused by a known and relatively constant set of etiological factors.8 Recent studies and surveys show that causes and incidence of maxillofacial trauma tend to vary with geographic region road safety regulation culture social education and behaviours.9
In the current study population 2nd to 3rd decade male gender was predominance. This finding is almost similar to the previous published studies.101112 This could be because this is a male dominating society where males are mostly involved in outside activities and more exposed to such accidents as compared to fe- males. Moreover the study was conducted in interior of
Sindh province where the culture and social behaviours restricts the females to domestic activities.
In contrast to this study 90% male population was the victim of maxillofacial trauma in Zimbabwe13 which is again explaining the male dominancy.
In this study road traffic accidents especially motorcyclists were the most common victims 59%. This could be because in our setup motor bikes are usually provided to youngsters and they use motorbikes rather
carelessly. Other study from Pakistan showed similar results (57%).14 Similar results were shown in studies from India (62%)15 and 52.2% Jordan16 whereas in a study from England only 24.7% patients were reg- istered with maxillofacial trauma due to road traffic accidents17 they were using the seat belts and were following traffic rules and regulations that decreased the ratio of injuries.
Second most common etiological factor noted in the present study was the interpersonal violence 10.76% Table 1. Current study was conducted in Larkana and its neighbouring small cities of interior Sindh located near the peripheral cities of Balochistan in these areas tribal fighting is common.
Mandible was the most common site involved 50.38% followed by zygomatic complex in this study. Similarly Cheema18 and Ahmed et al19 found 51% mandibular bone involvement which is almost equal to the results of this study.
In contrast to the present study Rana14 found 75.6% mandibular bone involvement which is quite higher percentage. In addition the involvement of site and occurrence varies with the mechanism of injury and gender and age for instance in road traffic accidents the most prevalent site is mandibular body and con- dyle20 while in younger age group condylar fractures are more common. In the current study it was the body of the mandible opposite to the findings by Motamedi MH21 who found condylar region as the more prevalent site.
Motor vehicle accidents due to the condition of the roads driving skills and violation of traffic rules was the main factor responsible for maxillofacial injuries which can be overcome by putting sufficient stress on the use of seat belts and head gears in case of motor- cycles and strict enforcement of traffic rules.
Following the comparison of the obtained data with literature it can be stated that causes and incidence would vary from one country to another still vary from rural to urban or from area to area.
1 Schaftenaar E Bastiaens GJ Simon EN Merkx MA.
Presentation and management of maxillofacial trauma in Dar es Salaam Tanzania. East Afr Med J. 2009 Jun; 86(6): 254-58.
2 Kieser J Stephenson S Liston PN Tong DC Langley JD.
Serious facial fractures in New Zealand from 1979 to 1998. Int
J Oral Maxillofac Surg. 2002 Apr; 31(2): 206-09.
3 Adekeye EO. The pattern of fractures of the facial skeleton in Kaduna Nigeria. A survey of 1447 cases. Oral Surg Oral Med Oral Pathol. 1980 Jun; 49(6): 491-95.
4 Khalil AF Shaladi OA. Fractures of the facial bones in the eastern region of Libya. Br J Oral Surg. 1981 Dec; 19(4): 300-04.
5 Van Hoof RF Merkx CA Stekelenburg EC. The different patterns of fractures of the facial skeleton in four European countries. Int J Oral Surg. 1977 Feb; 6(1): 3-11.
6 Hagan EH Huelke DF. An analysis of 319 case reports of mandibular fractures. J Oral Surg Anesth Hosp Dent Serv.
1961 Mar; 19: 93-104.
7 Gassner R Tuli T HAchl O Rudisch A Ulmer H. Cranio- maxillofacial trauma: a 10 year review of 9543 cases with
21067 injuries. J Craniomaxillofac Surg. 2003 Feb; 31(1): 51-61.
8 Khan SU Khan M Khan AA Murtaza B Maqsood A Ibrahim W et al. Etiology and pattern of maxillofacial injuries in the Armed Forces of Pakistan. J Coll Physicians Surg Pak. 2007
Feb; 17(2): 94-97.
9 Laskin DM Best AM. Current trends in the treatment of maxillofacial injuries in the United States. J Oral Maxillofac Surg. 2000 Feb; 58(2): 207-15.
10 Cheema SA. Zygomatic bone fracture. J Coll Physicians Surg
Pak. 2004 Jun; 14(6): 337-79.
11 Ferreira PC1 Amarante JM Silva AC Pereira JM Cardoso MA Rodrigues JM. Etiology and patterns of pediatric mandibular fractures in Portugal: a retrospective study of 10 years. J Craniofac Surg. 2004 May; 15(3): 384-91.
12 Afzal A Shah R. Causes of Maxillofacial Injuries - A three years study. J Surg Pak. 2001 Dec; 6(4): 25-7.
13 Jaber MA Porter SR. Maxillofacial injuries in 209 Libyan children under 13 years of age. Int J Paediatr Dent. 1997 Mar;
14 Rana ZA. An Assessment of Maxillofacial Injuries: A 5-year study of 2112 Patients. Ann. Pak. Inst. Med. Sci. 2010; 6(2):
15 Subhashraj K Nandakumar N Ravindran C. Review of maxillofacial injuries in Chennai India: a study of 2748 cases. Br J Oral Maxillofac Surg. 2007 Dec; 45(8): 637-39.
16 Bataineh AB. Etiology and incidence of maxillofacial fractures in the north of Jordan. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Jul; 86(1): 31-35.
17 Schaftenaar E Bastiaens GJ Simon EN Merkx MA.
Presentation and management of maxillofacial trauma in Dar es Salaam Tanzania. East Afr Med J. 2009 Jun; 86(6): 254-58.
18 Cheema SA Amin F. Incidence and causes of maxillofacial skeletal injuries at the Mayo Hospital in Lahore Pakistan. Br J Oral Maxillofac Surg. 2006 Jun; 44(3): 232-34.
19 Al Ahmed HE1 Jaber MA Abu Fanas SH Karas M. The pattern of maxillofacial fractures in Sharjah United Arab Emirates: a review of 230 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 Aug; 98(2): 166-70.
20 Adi M Ogden GR Chisholm DM. An analysis of mandibu- lar fractures in Dundee Scotland (1977 to 1985). Br J Oral Maxillofac Surg. 1990 Jun; 28(3): 194-99.
21 Motamedi MH. An assessment of maxillofacial fractures: a
5-year study of 237 patients. J Oral Maxillofac Surg. 2003 Jan;
|Printer friendly Cite/link Email Feedback|
|Author:||Shaikh, Mohammad Ilyas; Rajput, Fozia; Khatoon, Safia; Usman, Gulzar|
|Publication:||Pakistan Oral and Dental Journal|
|Date:||Jun 30, 2014|
|Previous Article:||Outcome of management of mandibular third molar impaction by comparing two different flap designs.|
|Next Article:||Hepatic trauma and associated injuries- experience in a tertiary care hospital.|